Emergency Medical Minute22 Huhti 2024

Episode 900: Ketamine Dosing

Contributor: Travis Barlock MD

Educational Pearls:

Ketamine is an NMDA receptor antagonist with a wide variety of uses in the emergency department. To dose ketamine remember the numbers 0.3, 1, and 3.

Pain dose

For acute pain relief administer 0.3 mg/kg of ketamine IV over 10-20 minutes (max of 30 mg).
Note: There is evidence that a lower dose of 0.1-0.15 mg/kg can be just as effective.

Dissociative dose

To use ketamine as an induction agent for intubation or for procedural sedation administer 1 mg/kg IV over 1-2 minutes.

IM for acute agitation

If a patient is out of control and a danger to themselves or others, administer 3 mg/kg intramuscularly (max 500 mg).
If you are giving IM ketamine it has to be in the concentrated 100 mg/ml vial.

Additional pearls

Pushing ketamine too quickly can cause laryngospasm.
Between .3 and 1 mg/kg is known as the recreational dose. You want to avoid this range because this is where ketamine starts to pick up its dissociative effects and can cause unpleasant and intense hallucinations. This is colloquially known as being in the "k-hole".

References

Gao, M., Rejaei, D., & Liu, H. (2016). Ketamine use in current clinical practice. Acta pharmacologica Sinica, 37(7), 865–872. https://doi.org/10.1038/aps.2016.5
Lin, J., Figuerado, Y., Montgomery, A., Lee, J., Cannis, M., Norton, V. C., Calvo, R., & Sikand, H. (2021). Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study. The American journal of emergency medicine, 44, 306–311. https://doi.org/10.1016/j.ajem.2020.04.013
Stirling, J., & McCoy, L. (2010). Quantifying the psychological effects of ketamine: from euphoria to the k-Hole. Substance use & misuse, 45(14), 2428–2443. https://doi.org/10.3109/10826081003793912

Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMS II

Kokeile Premiumia

Nauti 14 päivää ilmaiseksi

Tilaa Premium

Jaksot(1145)

Podcast 738: Acute Mesenteric Ischemia

Contributor: Ian Gillman, PA-C Educational Pearls: Acute mesenteric ischemia is a condition where bowel loses blood supply from an acute occlusion of the mesenteric arteries A frequent sign is abdomi...

14 Joulu 20212min

Podcast 737: TBI Outcomes

Contributor: Aaron Lessen, MD Educational Pearls: Study evaluating patient outcomes after traumatic brain injury (TBI) over 1 year Trial followed patients with severe TBI (GCS 3-8) and moderate TBI (...

13 Joulu 20212min

Podcast 736: Seasonal Affective Disorder

Contributor: Adam Barkin, MD Educational Pearls: Seasonal Affective Disorder (SAD) a form of seasonal depression which can result in trouble sleeping, concentration difficulties, changes in appetite,...

7 Joulu 20213min

Podcast 735: End Tidal CO2 and BiPAP

Contributor: Aaron Lessen, MD Educational Pearls: End tidal CO2 is accurate to 1-4 mmHg in intubated patient but use with those on positive pressure ventilation like BiPAP is unclear Study looked at ...

6 Joulu 20212min

Podcast 734: Push Dose Antibiotics

Contributor: Aaron Lessen, MD Educational Pearls: Recent study at a hospital in Chicago with a shortage of normal saline decided to push IV ceftriaxone rather than the typical infusion of the antibio...

1 Joulu 20212min

Podcast 733: Nitric Oxide for COVID

Contributor: Nick Hatch, MD Educational Pearls: Inhaled nitric oxide or Flolan may be considered in COVID Flolan is a prostaglandin can be inhaled or given IV These medications are classically us...

30 Marras 20215min

Podcast 732: Organophosphate Toxicity

Educational Pearls: Organophosphates affect the cholinergic system by inhibiting acetylcholinesterase affecting muscarinic and nicotinic receptors Symptoms include lacrimation, salivation, bronchocon...

23 Marras 20215min

Podcast 731: Fluid Resuscitation in Burns

Contributor: Chris Holmes, MD Educational Pearls: Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the ...

22 Marras 20214min

Kaikki yhdessä sovelluksessa

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi yhdessä paikassa.

Sinulle valikoitua sisältöä

Podme-sovelluksessa kokoat suosikkisi helposti omaan kirjastoosi. Saat meiltä myös kuuntelusuosituksia!

Jatka kuuntelua koska tahansa

Voit jatkaa siitä mihin jäit, myös offline-tilassa.

Premium

9,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa

Aloita 14 päivän kokeilu

Premium

13,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa
Yksi lisäkäyttäjä

Kokeile 14 päivää maksutta

Suosittua kategoriassa Tiede

Tarinat ja äänet, joita rakastat kuunnella

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi

Lue lisää